The present invention relates to novel compounds useful in the inhibition of the chemotactic activation induced by the fraction C5a of complement. Said compounds are useful in the treatment of pathologies depending on the chemotactic activation of neutrophils and monocytes induced by the fraction C5a of the complement. In particular, the compounds of the invention are useful in the treatment of sepsis, psoriasis, rheumatoid arthritis, ulcerative colitis, acute respiratory distress syndrome, idiopathic fibrosis, glomerulonephritis and in the prevention of injury caused by ischemia and reperfusion.
In response to immunologic and infective events, activation of the complement system mediates amplification of inflammatory response both via direct membrane action and via release of a series of peptide fragments, generally known as anaphylatoxins, generated by enzymatic cleavage of the C3, C4 and C5 complement fractions. These peptides include C3a and C4a, both of 77 aminoacids; in turn, C5 convertase cleaves the C5 complement fraction to give the glycoprotein C5a of 74 aminoacids.
The C5a peptide fragment of the complement has been defined as the “complete” pro-inflammatory mediator due to its chemotactic and inflammatory activity. In fact, other inflammatory mediators such as selected cytokines (IL-8, MCP-1 and RANTES, for example) are highly selective towards self-attracted cells, while others such as histamine and bradykinin are only weak chemotactic agents.
Convincing evidences support the involvement of C5a, in vivo, in several pathological conditions including ischemia/reperfusion, autoimmune dermatitis, membrane-proliferative idiopathic glomerulonephritis, airway irresponsiveness and chronic inflammatory diseases, ARDS and CODP, Alzheimer's disease, juvenile rheumatoid arthritis (N. P. Gerard, Ann. Rev. Immunol., 12, 755, 1994).
In view of the neuro-inflammatory potential of C5a/C5a-desArg generated by both local complement production and amyloid activation joined with astrocyte and microglia chemotaxis and activation directly induced by C5a, complement inhibitors have been proposed for the treatment of neurological diseases such as Alzheimer's disease (McGeer & McGeer P. L., Drugs, 55, 738, 1998).
Furthermore, the control of the synthesis of complement fractions is considered a promising therapeutic target in the treatment of shock and in the prevention of rejection during organ transplant (multiple organ failure and hyperacute graft rejection) (Issekutz A. C. et al., Int. J. Immunopharmacol, 12, 1, 1990; Inagi R. et at., Immunol. Lett., 27, 49, 1991). More recently, inhibition of complement fractions has been reported to be involved in the prevention of native and transplanted kidney injuries taking account of complement involvement in the pathogenesis of both chronic interstitial and acute glomerular renal injuries. (Sheerin N. S. & Sacks S. H., Curr. Opinion Nephrol. Hypert., 7, 395, 1998).
Characteristic neutrophil accumulation occurs in acute and chronic pathologic conditions, for example in the highly inflamed and therapeutically recalcitrant areas of psoriatic lesions. Neutrophils are chemotactically attracted and activated by the synergistic action of chemokines, IL-8 and Gro-α released by the stimulated keratinocytes, and of the C5a/C5a-desArg fraction produced through the alternative complement pathway activation (T. Terui et al., Exp. Dermatol., 9, 1, 2000). We have recently described a novel class of “omega-aminoalkylamides of R-2-aryl-propionic acids” as inhibitors of the chemotaxis of polymorphonucleate and mononucleate cells” (WO 02/068377). The novel class includes compounds ranging from selective C5a inhibitors to dual C5a/IL-8 inhibitors.
Furthermore, quaternary ammonium salts of omega-aminoalkylamides of R-2-aryl-propionic acids have been reported as selective inhibitors of C5a induced neutrophils and monocytes chemotaxis (WO 03/029187).